Remote Pre-Certification Specialist - Orthopedics

Orthos Inc; South Bend (IN); On-site; USD 42,000 - 66,000; Full time

Job summary

Orthos Inc. seeks a Pre-Certification Specialist to coordinate and maintain the flow of information through the managed care referral and authorization process.

You will work with physicians, clinical staff, insurance carriers, and other providers to ensure timely and accurate authorizations for patient services. Experience in orthopedics or spine-related terms is preferred, with strong communication and remote-work capabilities.

Qualifications

• High school diploma or equivalent required.
• Excellent verbal and written communication skills.
• Ability to efficiently gather, organize, review, and understand insurance, authorization, and patient account information.
• Proficient with multiple software systems; remote environment experience preferred.
• Confidentiality of medical records and patient information must be maintained.

Responsibilities

• Manage inpatient and outpatient referral and pre-authorization processes.
• Verify insurance coverage, in-network eligibility, benefits and authorization requirements.
• Contact referring physicians and insurance carriers to obtain required authorizations.
• Communicate with hospitals and healthcare facilities to obtain pre-certification numbers.
• Consult with physicians, nurses, staff, and providers regarding referral and pre-certification requirements.
• Maintain accurate documentation of referrals, authorizations, and related information.
• Assist with prescription verification and benefit inquiries as applicable.
• Participate in ongoing professional development to stay current on payer requirements.

Skills

Verbal communication

Written communication

Organizational skills

Analytical skills

Attention to detail

Remote work ability

Typing speed 50 WPM

Education

High school diploma or equivalent

College coursework / certification preferred

Job description

Orthos Inc. seeks a Pre-Certification Specialist to coordinate and maintain the flow of information through the managed care referral and authorization process.

You will work with physicians, clinical staff, insurance carriers, and other providers to ensure timely and accurate authorizations for patient services. Experience in orthopedics or spine-related terms is preferred, with strong communication and remote-work capabilities.